Abstract: Objective:To investigate the clinical value of anuspreserving operation for ultra low rectal cancer.
Methods:The clinical data of 226 patients with ultra low rectal cancer who were admitted to the Yijishan Hospital between January 2009 and September 2013 were retrospectively analyzed. All the patients were divided into the anuspreserving group (117 patients underwent traditional or modified Dixon operation) and the control group (109 patients underwent Miles operation). The operation time, volume of intraoperative blood loss, number of lymph node dissection, recovery time of intestinal function, postoperative shortterm amplications, local recurrence and distal metastasis of tumors, survival rate and quality of life in the 2 groups were analyzed. The measurement data with normal distribution were presented as ±s and analyzed using t test, count data were analyzed using Pearson chisquare test. The survival curve was drawn by KaplanMeier method, and the survival rate was analyzed using the Logrank test. The patients were followed up by regular outpatient examination and telephone interview up to September 2014.
Results:The traditional Dixon operation was performed on 108 patients, modified Dixon operation on 9 patients and Miles operation on 109 patients in the control group. The operation time and volume of blood loss were (117±12)minutes and (110±51)mL in the anuspreserving group, which were significantly different from (122±8)minutes and (155±44)mL in the control group (t=3.80, 7.09, P<0.05). The number of lymph node dissected and time of intestinal function recovery were 13±4 and (2.8±0.8)days in the anuspreserving group and 13±4 and (2.7± 0.7)days in the control group, respectively, with no significant difference (t=0.90, 0.83, P>0.05). Among the 184 patients receiving postoperative chemotherapy, 19 patients terminated the chemotherapy due to serious response to chemotherapy, 17 patients received radiotherapy after chemotherapy, 9 patients received interventional treatment for liver after chemotherapy and 42 patients didn′t receive the chemotherapy. The incidence of perianal eczema were 15.38% (18/117) in the anuspreserving group and 3.67%(4/109) in the control group, with a significant difference between the 2 groups (χ²=8.81, P< 0.05). The cases of anastomotic leakage, intraabdominal bleeding, intraabdominal infection, postoperative urinary retention, infection of incision and incision dehiscence were 4, 3, 5, 10, 7 and 9 in the anuspreserving group, which were not significantly different from 0, 2, 4, 11, 8 and 5 in the control group (χ²=1.86, 0.14, 0.05, 0.16, 0.19, 0.94, P>0.05). Onehundred and ninety patients were followed up for a median time of 34.5 months (range, 12.0-57.0 months). The rate of local tumor recurrence, rate of distant metastasis and 1 and 3year survival rate were 8.55%(10/117), 5.98%(7/117), 94.8% and 76.2% in the anuspreserving group and 8.26%(9/109), 5.50%(6/109), 95.7% and 76.1% in the control group, with no significant difference between the 2 groups (χ²=0.01, 0.02, 0.08, 0.00, P>0.05). The score of life quality was 66±14 in the anuspreserving group, which was significantly higher than 49±11 in the control group (t=10.13, P<0.05).
Conclusion:The anuspreserving operation for ultra low rectal cancer is safe and feasible based on strictly grasping operative indications , meanwhile, it can improve the postoperative life quality of patients.